Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study

Management of pediatric sternal wounds following congenital heart surgery: The role of the plastic surgeon in debridement and closure

“…The tenets of sternal wound management in adult patients—aggressive debridement of nonviable and infected tissues, removal of all internal hardware, and coverage with healthy vascularized soft tissue—are often applied, but at times, may need to be modified in this unique subset population. The literature supports the use of conventional adult treatments in the pediatric patient population including continual catheter antibiotic irrigation, fluid drainage, dressing changes, and more recently, NPWT 3,9,10 . A study by Horácio et al 11 demonstrated conservative use of unilateral pectoralis major muscle flaps as an option for preserving functionality while achieving good cosmetic results.…”

Does a good beginning make a good end? The importance of biocompatibility

“…The second-generation fixation device used in the report of Allen and colleagues 1 achieved excellent long-term outcomes without any late complications requiring plate removal as late as 6 months after the fixation. 1 Implant failures from metal fatigue, less flexibility, and chronic pain are likely to occur after chest wall osteosynthesis, however, especially in osteoporotic or obese patients with anteriorly placed implants, [4][5][6] which suggests that long-term observation longer than 6 months may be necessary to validate the rigid fixation. One of these causes is associated with repeated and concentrated load at one point on a plate, and to minimize potential harmful effects, biomaterials with good biocompatibility and optimal mechanical properties that can correspond to the flexible respiratory movements are therefore desirable, and they will also facilitate repeated sternotomies because of the minimal reactions to the normal tissues.…”

“…In reopening cases, rigid fixation has to be achieved again with the potholed sternum caused by the first screwing. Because reopening after rigid fixation was not described in detail, 6 we request the technical details regarding reopening and refixation.…”

“…4,5 Similar to dentistry, situations arise in trauma and orthopedics when there is a need for osteoconductive material to treat fractures associated with tissue loss or contaminated wounds (ie, compound fractures or osteomyelitis). 6 Authors have nothing to disclose with regard to commercial support.…”